Diabetes mellitus includes diabetes mellitus types 1 and 2. Diabetes mellitus type 2 (sometimes referred to as diabetes mellitus type II and adult-onset diabetes) is a metabolic disorder typically involving insulin resistance, in which the cells of the body of an individual do not respond appropriately when insulin is present. If unnoticed or left untreated, severe complications can result, including renal failure, blindness and wounds that fail to heal. While there is an inheritable genetic connection, more than 80% of the individuals with diabetes type 2 are overweight or obese. Diabetes mellitus type 1 usually results from an autoimmune disorder that destroys pancreatic beta cells which produce insulin.
Metformin (1-(diaminomethylidene)-3,3-dimethyl-guanidine) is an anti-diabetic drug having the formula C4H11N5. available by prescription under the trade names Glucophage™, Diabex™, Diaformin™ and others, with generic forms available. Metformin appears to reduce hepatic gluconeogenesis, decrease absorption of glucose from the gastrointestinal tract and increase insulin sensitivity. Adverse effects include impaired liver or kidney function, diarrhea, cramps, nausea, vomiting, mal-absorption of vitamin B12 and possible B12 deficiency. Metformin is available in immediate release formulations of 500 mg., 850 mg., and 1000 mg. tablets and in slow and extended release formulations of 500 mg. and 750 mg.
Metformin is often prescribed with rosiglitazone, one form of which is marketed under the trade name Avandia®. While Avandia® has been approved by the Food & Drug Administration (FDA) to treat diabetes mellitus, the FDA recently issued a safety alert on Avandia®, stating that                Safety data from controlled clinical trials have shown that there is a potentially significant increase in the risk of heart attack and heart-related deaths in patients taking Avandia. However, other published and unpublished data from long-term clinical trials of Avandia, including an interim analysis of data from the RECORD trial (a large, ongoing, randomized open label trial) and unpublished reanalyses of data from DREAM (a previously conducted placebo-controlled, randomized trial) provide contradictory evidence about the risks in patients treated with Avandia.        Patients who are taking Avandia, especially those who are known to have underlying heart disease or who are at high risk of heart attack should talk to their doctor about this new information as they evaluate the available treatment options for their type 2 diabetes.        FDA's analyses of all available data are ongoing. FDA has not confirmed the clinical significance of the reported increased risk in the context of other studies . . . .        
For some patients, the uncertainly of such risks, as well as problems associated with long-term use of Metformin (e.g., need for increased dosages over time), results in an ongoing search for alternatives to address symptoms and underlying physiological conditions related to diabetes mellitus.
Metformin is also prescribed with Amaryl®, available from Sanofi-Aventis and also generically available as glimepiride. Amaryl® is a long-acting, III generation sulfonylurea: 3-ethyl-N,N-bis(3-ethyl-4-methyl-2-oxo-5H-pyrrol-2-yl)-4-methyl-2-oxo-5H-pyrrole-1-carboxamide. Glimepiride lowers blood glucose levels by stimulating pancreatic beta cells to produce more insulin and by inducing increased activity of peripheral insulin intracellular receptors. However, gastrointestinal disturbance can result.
Lantus®, an insulin analogue used to help control blood sugar levels, is prescribed to complement the shorter-acting sulfonylurea drugs. Lantus® is characterized as having a 24-hour duration of action, thereby resembling basal insulin secretion of pancreatic beta cells and minimizing nocturnal hypoglycemia. However, Lantus® typically requires the support of a fast acting insulin taken with food to reduce the effect of meal-derived increase in blood glucose levels.
Exenatide, marketed under the trade name Byetta® and available from Eli Lilly and Company, constitutes a new class of medications approved for treating diabetes. Exenatide is a peptide containing 39 amino acids which functions as an insulin secretagogue and has glucose regulating capabilities. Exenatides are often combined with Metformin and sulfonylureas to improve glucose control. However, exenatides do have some adverse qualities, e.g., they require administration by injection and cause gastrointestinal disturbances in some patients. Exenatide may also increase risk of sulfonylurea-induced hypoglycemia.
Thus, while the above drug therapies, alone and in combination with each other and with other drugs provide significant and life-extending relief from diabetes mellitus, typically, over time, dosages must be increased and new combinations of drugs tried for an individual with diabetes mellitus to maintain acceptable blood glucose levels and a satisfactory life style. As increased dosages and/or combinations are prescribed, treatment costs may increase, the presence of side effects may become manifest, and administration by injections (as compared to oral regimens) may be required. For these reasons, use of nutritional supplements to prevent or control diabetes mellitus has been explored.
U.S. Pat. No. 6,203,819 entitled Dietary Supplement and Method of Treatment for Diabetic Control, discloses a daily nutritional supplement to assist in the metabolism of glucose. So-called “anchor components” include chromium polynicotinate, picolinate, vanadyl sulfate, vitamin E natural, standardized willow bark (as a source of aspirin), magnesium chloride, citrate, fumarate, malate, glutorate, and succinate complex, folic acid and alpha-lipoic acid. This nutritional supplement is more succinctly described in the Summary of the Invention as comprising effectives amounts of sources of chromium, vanadium, magnesium, vitamin E, aspirin, folic acid and alpha-lipoic acid. Essential components claimed include chromium, vanadium and aspirin. However, vanadyl sulfate has been reported to cause gastrointestinal distress and there remains some question about disposition of vanadium in the body after long-term ingestion.
U.S. Pat. No. 6,585,998 entitled Nutraceutical Composition, relates to a nutraceutical composition which is used to maintain normal blood sugar levels and normal levels of non-enzymatic protein glycosylation. The composition requires at least 7 constituents: a tripeptide component, guanidine hydrochloride, alpha-lipoic acid, a brazilin component, an amino acid component, a flavonoid component and a catalase. The addition of selenium is also suggested.
Accordingly, there remains a need for a simplified medical food or nutritional supplement effective to manage blood glucose levels in individuals generally and pre-diabetic individuals in particular, and to assist individuals with diabetes mellitus in the management of their condition.